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Population-Level Healthcare Management


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NHS organisations are starting to understand the value of the data sitting dormant in every GP practice.

Population Level Health tools can screen for risks to patients and identify when improvements can be made. So why aren’t all NHS organisations doing it? What is stopping them from using the terabytes of data they hold to improve people’s lives, reduce harm and deliver better outcomes? Could it be concerns about data security, system complexity or something else?

Carl Woodroffe discusses the challenges presented by the NHS’s commitment to scale-up population health management from his own personal experience.

Digital Primary Care Congress: The Information Revolution, Manchester.


Published in: Healthcare
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Population-Level Healthcare Management

  1. 1. Population Level Healthcare. Carl Woodroffe Business Development Manager Digital Primary Care Congress: The Information Revolution
  2. 2. “Population Level Healthcare aims to improve the health outcomes for all patients within a population” “They must ensure that clinicians are fully informed how to treat patients optimally and ensure that the right thing is done first time, every time, for every patient” “Variation is often the enemy of quality” Population Level Healthcare.
  3. 3. PINCER • Pharmacist led intervention to improve the safety of prescribing • 1 in 20 prescriptions contain an error • Hazardous GP prescribing contributes to 1 in 25 admissions • Significant reduction in hazardous prescribing especially for patients with: • GI Bleeding • Heart Failure • Kidney Injury
  4. 4. CCG – Concerned with levels of AKI. ‘Lots of Variation’ ‘Poorly managed’
  5. 5. Where, Why, Who, How? • Is it my practice? • I don’t believe your data. • How can I verify your figures? • Are we aware of the patients? • Who are they? • How can we stop this happening?
  6. 6. 0 50 100 150 200 250 300 350 400 450 500 Baseline Year 1 Year 2 BP Checked Creatinine Checked Medication reviewed Number of cases 3 Months Post AKI Care
  7. 7. Practice Analysis Creatinine checked < 3 months of diagnosis >80% 60-80% 40-60% 20-40%
  8. 8. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% xxx050 xxx342 xxx059 xxx450 xxx331 xxx082 xxx224 xxx289 xxx190 xxx308 xxx108 xxx208 Creatinine checked BP Checked Medication reviewed Practice Analysis
  9. 9. The answer. • Give clinicians the tools to identify these • Alerts • Templates • Practice Reports • Share aggregate reports with PCNs, CCGs & STPs • Discuss, accept, learn, adapt.
  10. 10. • Easy for you to implement • Integrates with EMIS, TPP & Vision • Funded under GPSoC Takeaways